入院及住院日适当性评价方法介绍

医院平均住院日已成为衡量医院效率和医疗质量的重要指标.对在国外已得到普遍应用的人院及住院日适当性评价方法(AEP)及其应用进行介绍,利用AEP进行回顾性研究,从组织诊断的角度,分析和识别导致不适当住院日的医院内部因素,发现医院流程设计、资源配置、患者支付方式、医疗卫生体制等方面的问题并加以改进,为进一步提高卫生资源的使用效率、缩短平均住院日,提供理论和方法指导.     

上海市某医院股骨头坏死病人不适当住院日研究

入院及住院日适当性评价方案是基于医疗和技术标准的、独立于各病种的评价工具，在诊断不明确或不正确的情况下也能使用。评价住院日是否适当的方法是对每份病案进行回溯性评价，对病人住院的每一天进行考察，如果该天符合标准中的某一项，则该天的住院是合适的，如果不符合任何一项，则是不合适的。对2007年全年股骨头坏死出院病人，共计351例进行住院日适当性评价。     

慢性阻塞性肺疾病患者住院日适当性评价与分析

目的分析某院慢性阻塞性肺疾病（COPD）患者住院日的适当性及其影响因素,为进一步研究提供依据。方法利用国际上广泛应用的入院及住院日适当性评价方案评价标准,采用回顾性调查的方法对某院2011年入院的COPD患者的350个住院日进行适当性评价。结果 15.4%的住院日被判定为不适当住院日,影响患者住院日适当性的主要因素是费用支付方式和住院天数。结论本研究不适当住院日所占比例较低,但是需进一步研究,并制定本土化适当性评价标准。     

新疆某三甲医院住院日适当性评价研究

目的分析新疆某三甲医院不适当住院日的比例及产生原因。方法采用AEP住院日标准及不适当住院日原因分析参考延迟评判工具"The Delay Tool"分层抽样抽取新疆某三甲医院2012年5月28个临床科室200份病案3 204个住院日进行回顾性研究。结果 6.3%的住院日是不适当的;引起住院日不适当的三大原因是等待检查报告延误、出院不及时延误和等待手术延误占不适当住院日的73.89%,按医院规定进行修正后不适当住院日比例为5.6%。结论与国内相关研究结论比较发现此次研究不适当住院日处于相对较低水平。     

结核病患者住院费用与住院日分析

目的通过分析医院结核病患者的住院费用及住院日,为医院控制病人医疗费用,提高医疗效益提供决策依据.方法分析2001-2004年间广州市胸科医院结核病患者的各项住院费用的构成、年龄、性别各影响因素及住院日信息.结果2004年结核病患者平均住院日30天,人均医疗费用14993元,2001-2004年呈现平均住院日下降,日均住院费用上升的趋势.结论加强医院医疗质量管理,缩短平均住院日,严格控制医疗费用增长,以减轻结核病人的医药费用负担,推动医院和谐健康发展.     

平均住院日影响因素的线性回归分析

目的：通过对云南省某三甲医院平均住院日现状的研究,分析影响平均住院日的因素,从而对有效控制医院平均住院日提出相应的措施,科学合理地缩短医院的平均住院日。方法用 Excel 对医院平均住院日相关数据进行描述性分析,运用多重线性回归分析对我院平均住院日进行分析,寻找其影响因素。结果云南省某三甲医院2009-2013年平均住院日总体呈下降趋势,平均住院日主要与费用、疾病权重、死亡情况、外科系统的手术情况等关系较大。结论近年来平均住院日缩短,有利于医院医疗质量及数量的提高,减轻患者负担,提高医院的社会效益和经济效益。     

实施当日出院制度对平均住院日的影响及意义

目的探讨实施当日出院制度对缩短平均住院日的作用和意义。方法收集医院2013年度医疗数据,运用描述性统计学方法和线性回归当日出院和平均住院日的相关性进行分析。结果 2012年11月—2013年10月,全院平均住院日呈逐月下降趋势,同时住院患者当日出院比例增长明显。平均住院日和当日出院比例散点图显示相关性,线性回归分析具有统计学意义,两者呈高度负相关（r=-0.739,P=0.006）。结论住院患者当日出院比例对平均住院日有显著影响。为进一步缩短平均住院日,相关职能部门可以采取优化流程、加快出院结算、放开住院病患当日出院服务的政策措施。     

结核病患者住院费用与住院日控制探讨

目的通过分析医院结核病患者的住院费用与住院日,为医院控制病人医疗费用的开支,健全医疗管理标准,加强医疗质控,提高医疗效益提供准确依据。方法分析结核病患者医疗费用、各项住院费用、年龄、性别及各因素分类统计的费用及住院日信息。结果2003年结核病患者平均住院日38天,人均医疗费用16169.1元,2001~2003年均呈现住院日下降,每床天费用上升的趋势。结论必须通过加强医院医疗质量管理,缩短平均住院日,严格控制医疗费用增长才能促使医院长期健康发展。     

呼吸系统疾病患者自身因素对住院费用与住院日影响分析

目的 通过分析呼吸系统疾病患者的住院费用及住院日,为医院控制病人医疗费用,提高医疗效益提供依据. 方法采用比较法分析 2006-2008年某三甲医院呼吸科3年全部住院患者的人均住院费用与住院日的关系,及不同年龄、性别对住院日的影响. 结果 2006年平均住院日14.43天,2007年平均住院日13.97天,2008年平均住院日13.37天,而日均住院费用由2006年的536.86元上升到2008年的680.15元.2006-2008年呈现平均住院日在逐年降低,而日均住院费却显著上升. 结论缩短住院日只是控制医疗费用增长的一方面,降低住院费用还要从多方面考虑.     

口腔医院超长住院日病例统计与分析

目的了解超长住院日出院患者情况,为降低平均住院日提供数据支持。方法对某口腔医院2009-2013年住院日超过30天的234例患者的相关信息进行回顾性分析。结果超长患者占同期出院人数的1%,住院日占3.9%。超长患者在年龄、平均住院日、术前平均住院日、人均住院费与全部患者差异均有统计学意义。排名前两位的疾病是:恶性肿瘤和颅颌面畸形,共160例,占68.4%。院内感染率19.2%,非计划再次手术率15.0%。结论定期通报和重点监测住院日超过30天患者的情况,关注年龄和疾病谱,降低术前平均住院日,控制院内感染与术后并发症等会降低平均住院日和医疗费用。     

Appropriateness evaluation of short hospital admissions using Appropriateness Evaluation Protocol (Italian version): experience of a teaching hospital

Italian version of Appropriateness Evaluation Protocol (AEP) is a tool for evaluating the appropriateness of hospitalization for acute patients. In particular, it aims to verify and quantify the reasons of appropriateness associated to the day of admission and the single days of hospital stay. The aim of the present paper is to evaluate the appropriateness of ordinary, 2-3 days lasting, hospital admissions within an university hospital. We examined a sample of 518 hospital admissions: 370 admissions (71%) lasting 2 days, and 148 admissions (29%) lasting 3 days. Results analysis showed different levels of appropriateness between the 2-days and the 3-days admissions: the appropriate admissions were 18% in the sample of the 2-days admissions and 38% in the sample of 3-days admissions. Most inappropriate days of admission and stay in hospital are due to attended or to the execution of diagnostic procedures. In order to evaluate accuracy by means of AEP methodology, it is necessary to improve the quality of medical documentation using standardized medical records. AEP, in the framework of the continuous quality improvement, is a valid tool to reorganise health care processes.     

剖胸术后手术部位感染的直接经济损失评价 FREE

目的了解剖胸术后手术部位感染的直接经济损失。方法回顾性调查剖胸手术患者出院病历,对手术部位感染（病例组）与同期住院未感染的手术患者（对照组）按1∶1配比法进行剖胸术后手术部位感染的直接经济损失研究。结果病例组的住院费用中位数为25 911.70元,对照组为19 899.75元,前者显著高于后者（t=5.67,P=0.00）;病例组住院日中位数为32.50 d,对照组为19.50 d,延长13 d,两组差异有高度显著性（t=10.02,P=0.00）。结论手术部位感染大大增加了医疗费用支出,延长了住院日。我们应增加医院感染预防控制的投入以减少医院感染发生率及其所致的经济损失。     

Using length of stay and inactive days in the hospital to assess appropriateness of utilisation in Barcelona, Spain.

STUDY OBJECTIVE: To compare the level of inappropriate utilisation of a teaching hospital in two different calendar years and to analyse the relationship between changes in appropriateness of utilisation and changes in average length of stay. DESIGN: Retrospective evaluation of the medical records of patients admitted to a hospital in two periods: 1988 and 1990. SETTING: Hospital Universitari del Mar, a teaching hospital with 440 beds located in Barcelona, Catalònia, Spain. PARTICIPANTS: Medical records were randomly selected from records of adults discharged from hospital with a principal diagnosis other than normal delivery or any psychiatric condition. Altogether 750 records with complete data were reviewed for 1988 and 633 for 1990. MEASUREMENTS AND MAIN RESULTS: The appropriateness evaluation protocol (AEP) was used to assess whether or not the admission and each day of the hospital stay were appropriate. For data analysis we used the extension of logistic regression that allows quantification of within-patient clustering of inactive days. The average length of stay (LOS) was 11.7 days in 1988 and 9.5 in 1990 (p < 0.001). In contrast, the proportion of inappropriate admissions was 12% in 1988 and 19% in 1990 (p < 0.001). Among those patients who were appropriately admitted, the average odds of a given day being inactive in 1990 was no lower (OR = 1.09) than the odds in 1988, but the clustering of inactive days was significantly (p < 0.001) lower in 1990. CONCLUSIONS: In the hospital studied, a lower average length of stay was not associated with an improved level of appropriate utilisation. Policies exclusively focused on lowering LOS may not directly lead to a reduction in inappropriate hospital utilisation.     

肺部感染患者住院费用及病死率的影响因素分析

目的调查广州市某三甲医院肺部感染患者住院费用、住院日数及病死情况,并探讨其影响因素,为医院进一步采取针对性的感染控制措施提供科学依据。方法收集该院2011年1月—2012年12月住院诊断为肺部感染患者的病案首页资料,采用单因素分析、多元线性回归和logistic回归法比较不同类型肺部感染患者住院费用、平均住院日和预后的差异及其影响因素。结果10 431例肺部感染患者住院费用平均为(29 081.95±38 682.92)元,中位数为16 085.25元;住院日平均为(15.93±20.54)d,中位数为13.00d;共有828例患者经治疗无效后死亡,病死率7.94%。不同性别、年龄、付款方式、入院病情、肺部感染类型以及手术与否的肺部感染患者住院费用和住院日数差异均有统计学意义(均P0.05),不同年龄、付款方式、入院病情、肺部感染类型以及手术与否的肺部感染患者死亡率差异也有统计学意义(P0.05);影响肺部感染患者住院费用从大到小的因素依次为住院日数、是否手术、付款方式(公费医疗)、肺部感染类型(HAP)、年龄、性别等,影响其住院日数的因素从大到小依次为是否手术、肺部感染类型(HAP)等,造成其死亡的危险因素有入院情况、肺部感染类型以及是否手术等。结论控制医院肺部感染,对有效控制住院费用,缩短平均住院日,提高患者生存率具有重要作用。     

Appropriateness of hospital utilisation in Italy

The purpose of this study was to determine the extent of inappropriate hospital admission and inappropriate days of stay and the effect of variables on such inappropriateness on an adult population in Italy. A review was made of medical records of patients admitted to any one of the following specialities: medicine, surgery, gynaecology or traumatology/orthopaedics at one of five hospitals located respectively in Siena, Frosinone, Rome and Catanzaro, and who were in-patients during one of four pre-selected index days. To determine the appropriateness of hospital admission and length of hospitalisation, a retrospective application was made using the Italian version of Appropriateness Evaluation Protocol (AEP). A total of 1299 patient days were reviewed.14.2% of the hospital admissions and 37.3% of the number of hospitalisation days were judged to be inappropriate. Multiple logistic regression analysis showed that inappropriate admission was significantly increased with relation to: greater distance from hospital to patient's home; admission to a medical ward; planned admissions; and admission over a weekend. Multiple logistic regression analysis indicated that the inappropriate number of days of hospitalisation was significantly higher for medicine and for patients who were inappropriately admitted.The main reason for categorising an admission as inappropriate was that the patient's problems could be treated on an out-patient basis, and, for inappropriate days of care, the physician was overtly cautious in the management of a patient.Changing the physicians' behaviour and the organisation of hospital activities may be effective in improving the quality and efficiency of hospital care. Public Health (2000) 114, 9–14.     

Appropriateness of hospital use: Report from an Italian study

The objective was to assess the extent of inappropriate hospitaladmission and stay in an adult patient population and identifypotential correlates of such inappropriateness. Design: a cross-sectionalsurvey on a sample of 1,082 in-patients using a modified versionof the appropriateness evaluation protocol (AEP). Setting: adultacute departments in a 950 bed teaching hospital in the greaterMilan area. The patient sample consisted of patients cared forat 1 of the participating departments on any of 3 Index daysbetween October 1989 and June 1990. The results show that overall27% of the admissions and 40% of the hospital days were inappropriate.The rate of inappropriate admissions was higher for patientsadmitted during week days and was also significantly associatedwith the admitting ward and the age of the patient. Inappropriatehospital-day stays were related to the type of ward and to thelocation during the stay, with those sampled In the later partof their stay having the highest rate of inappropriateness.Most of the hospital days rated as not appropriate did not requireany further stay (75%). Conclusions: a substantial proportionof hospital use was found to be medically unnecessary and, forthe most part, due to hospital functioning or the behaviourof the doctors. Some properties of the AEP (high inter-raterreliability, predictivity of expected associations) were alsoconfirmed. The basic features of this revised version of theAEP make it a good candidate for becoming of great importancein monitoring the effect of the changes the Italian NationalHealth Service is currently undergoing.     

参保心力衰竭患者住院费用及影响因素分析

目的了解天津市参加城市居民基本医疗保险的心力衰竭患者住院费用构成及其影响因素,为合理控制住院费用提供参考依据。方法从天津市2004-2007年城市居民基本医疗保险数据库中随机抽取心力衰竭确诊患者307例,对其住院费用情况进行回顾性分析。结果天津市2004-2007年参保心力衰竭患者人均住院费用为9 266.61元,其中一级医院为3 517.34元,二级医院为5 890.92元,三级医院为10 313.73元;参保心力衰竭患者药品费、检查费、治疗费、手术费、床位费、医用材料费、成分输血费和其他费用分别为5 379.29、1 380.62、1 532.33、28.21、422.54、473.42、1.43和48.76元,分别占58.05%、14.90%、16.54%、0.30%、4.56%、5.11%、0.02%和0.53%;多元线性回归分析结果表明,医院级别越高、住院天数越多和手术治疗的心力衰竭患者住院费用越高;女性心力衰竭患者住院费用低。结论性别、医院级别、住院天数和手术治疗是天津市参保心力衰竭患者住院费用的主要影响因素。     

山西省2003—2012年胃癌患者住院费用影响因素分析

目的探讨山西省胃癌患者住院费用的影响因素, 为政府合理分配卫生资源、完善医疗保障制度以及卫生经济学评价提供依据。方法对山西省长治地区三级甲等综合医院和平医院2003—2012年3 151例胃癌患者的住院费用进行统计描述, 并采用多元线性逐步回归模型分析住院费用的影响因素。结果2003—2012年3 151 例胃癌患者的平均住院天数中位数为16 d, 人均住院费用为15 888.97元, 日均住院费用为911.37元, 且呈逐年上升趋势;住院费用构成中, 药品费所占比例最大(36.59%), 其次是手术费所占比例(15.85%);影响住院费用的主要因素依次为:是否手术、住院天数、药占比、付费方式、有无合并症、治疗结果和职业类型(均P<0.05)。结论胃癌患者的住院费用相对较高, 应进一步完善医疗保障制度等措施以最大限度的降低胃癌患者的住院费用。     

参保脑卒中患者住院费用影响因素分析

目的 探讨参保脑卒中患者住院费用构成及其主要影响因素,为合理控制医保费用过快增长、完善医疗保障制度和减轻患者经济负担提供参考依据。方法 2015年5月,回顾性收集安徽省某三甲综合医院12 363例主要诊断为脑卒中的出院患者的病例资料,对患者的一般情况及住院费用构成进行描述性分析,采用单因素分析及多元线性逐步回归分析探讨住院费用的主要影响因素。结果 安徽省某三甲医院2005-2014年参保脑卒中患者例均住院费用为7 746.74元,例均住院费用呈逐年上升趋势（P<0.01）;参保脑卒中患者药品费、耗材费、检查费、治疗费、检验费、床位费、护理费等费用分别为4 736.82元（63.33%）、90.83元（12.20%）、590.00元（7.28%）、433.00元（5.82%）、453.80元（5.72%）、216.00元（2.94%）和132.00元（1.92%）;平均住院日为14.28 d,中位数为12 d;多元线性回归分析显示,住院日是参保脑卒中患者住院费用的首要影响因素,住院时间越久、药占比越高、疗效越差、入院Rankin评分越高、年龄越大、存在手术情况的参保脑卒中患者住院费用高于无上述情况的患者。结论 降低参保脑卒中患者住院费用的不合理增长应以合理缩短住院日、降低药占比为突破口,采取综合措施控制相关因素。